In Mad House, Clea Simon has combined her personal story with a self-help book. First, there is her own story. She grew up in the 1960s and 1970s on Long Island, with a brother and sister 10 and 8 years older than her. Both of them developed schizophrenia in their teens. She explains what happened from her perspective in her family during that difficult time. Eventually she left home and went to Harvard, and although she no longer was in contact with her siblings, she relates how her choices of lovers and friends were still influenced by those early family psychodynamics. She does this using the hindsight gained from years of psychotherapy, so she can explain how she came to be attracted to people who were similar to her brother and sister. As so many of us do, she unconsciously lives in the past, using her relationships in the present to try to solve the problems she experienced in childhood. For her, this meant choosing men who are emotionally unable to sustain a relationship. But through therapy, she gradually gains an understanding of her actions, and begins to be able to break the pattern she has established. This is a story of hope.

The other book here is basically pop-psychology for siblings of the mentally ill, especially younger siblings as Simon is. She has interviewed many other people who have had similar experiences as herself, and she inserts their insights into the chapters at appropriate times. She also quotes some mental health experts and cites some of their books as she goes along. Simon's chosen profession is journalism -- she is an editor for a Boston newspaper and a national public radio station -- and these parts of the book read like transcriptions of NPR stories.

The two books do not fit well together. Simon's snippets of other people's comments are the text equivalent of sound bites. They don't really tell us anything new: she just uses them to bolster a point she has already made. These more general discussions are presumably meant to show Simon's personal experience is representative of that of many siblings of the mentally ill, and make her story one that many others can learn from. But really these excursions into more general topics just interrupt the flow of Simon's telling of her own life. I found myself skipping pages to get back to the details of her own life, which was much more interesting than the rather trite observations she makes about other people's experience. Furthermore, readers should be quite capable of comparing their own lives with the authors. For instance, Jay Neugeboren's memoir of his brother Robert's mental illness, Imagining Robert, provides a wealth of useful information without lapsing into 'self-help' talk. (I reviewed Imagining Robert in 1998 in Metapsychology.)

Neugeboren's memoir provides a telling comparison point to Simon's Mad House. The two authors have very different stories. While Simon was the youngest in her family, Neugeboren was the elder of the brothers. Simon spent much of her life avoiding her siblings and excelling in school and work as a way to compensate her parents for their disappointment in their other children. Once her siblings left home, the three of them remaining engaged in the implicit (and sometimes explicit) pretense that that the mentally ill children had never existed. Life was very different for Jay Neugeboren, who sided with his brother against their parents in family disputes. As their parents became more unwilling or unable to cope with Robert, it was largely Jay who took on the extra responsibilities. He makes clear how difficult it can be having a brother with mental illness, but his emphasis is generally on the failings of the mental health industry and the lack of tolerance that society has for the mentally ill. Simon instead puts her emphasis on how difficult her life has been, and how she has required many years of psychotherapy to sort through the psychological problems that had their genesis in her childhood and adolescence.

While Clea Simon makes a strong case for the underdiscussed effects on siblings of the mentally ill, her book seems narrow because it does not put the larger issues into social context. For example, it does not have clear suggestions for how we could improve the mental health system. She spends little time on how her parents experienced the turmoil of their children's mental illnesses. A crucial time in her story is her brother's death. Late in the book, she tells us what she learned many years after, that he killed himself. But when she first describes the incident, she simply tells the reader what her parents told her, that he was in a car accident. She complains that her parents were very matter-of-fact in their giving of the bad news, giving it to her on the same day as telling her cat had died. But she makes no attempt to explore their grief. Maybe that isn't her job here, since it is not what her book is about. But she does not say much about her own grief either. She seems aware of how she wasn't in touch with her own pain -- she writes about going up to her old bedroom in her parents' house on the day she learned of her brother's death and her main emotion was feeling the emptiness created by the absence of her cat. Further evidence of her denying her brother's existence come from the fact that she did not mention his death to any of her college friends at the time. It is, of course, understandable that she would be highly ambivalent about the loss of her brother, who caused her such disappointment and confusion when she was a child and his illness progressed. Her unwillingness to talk about the death then may have been a way of dealing with the pain. It may have also helped her to avoid the irrational stigma of with coming from a family of mad people. But never in the book does Simon adequately return to the topic of her brother's death, and one is left feeling that maybe she is still avoiding dwelling on what his loss means to her.

Coming to the end of this book, I was reminded of a moment in Janet Malcolm's Psychoanalysis:The Impossible Profession where the reptilian psychoanalyst who has been her main subject disdains a patient's thanks for how much he has helped her. He interprets the patient's gratitude as a symptom of an unresolved transference, and comments that the therapy has been successful when the patient no longer gives a second thought to the analysis or the analyst. Even though that psychoanalyst's attitude seems to betray a fundamental lack of familiarity with human warmth and the kind of love that can exist between a therapist and patient, nevertheless there was also an insight there. As it is now, Mad House lacks resolution: Simon has told the reader how she survived her childhood and how she managed to break out of the self-defeating patterns of behavior that she had learned. But resolution requires more than that, and I'd like to know whether Simon, through her therapy and through reflecting on her life in writing, feels that she has she has come to terms with her past and is able to move on.